Ted Oshman: How Medical Teams Can Prevent Palsy Injuries During Delivery

According to Theodore Oshman, Birth-related palsy injuries, while relatively uncommon, can have long-lasting impacts on a child’s physical development and a family’s emotional well-being. These injuries often stem from complications during labor and delivery, many of which are preventable with proper precautions. Clear communication, early risk identification, and adherence to practices during childbirth are central to promoting safety. When injuries do occur, timely diagnosis and support can make a crucial difference in recovery.

Understanding Palsy Injuries in Newborns

Palsy injuries during birth typically involve damage to a newborn’s nerves, most often affecting the brachial plexus or facial nerves. These injuries can occur when there is excessive pressure or stretching of the baby’s head, neck, or shoulders during delivery. In many cases, the impact is temporary, but some children experience weakness, limited mobility, or developmental delays. Brachial plexus palsy, such as Erb’s palsy, can limit arm motion if nerves become torn or compressed.

Risk Factors Before and During Labor

Certain risk conditions can increase the likelihood of a newborn sustaining a palsy injury. Babies with higher birth weights, especially those over nine pounds, are more prone to shoulder dystocia, where the shoulder gets stuck behind the mother’s pelvic bone during delivery. Maternal factors like gestational diabetes and obesity also raise the risk, as they can contribute to macrosomia or complicate the delivery process. While instruments such as forceps or vacuum extractors can assist with delivery, they must be used with care, as improper use can place unnecessary strain on the baby’s head or neck.

Early Identification and Team Communication

During prenatal visits, healthcare providers should assess maternal health, fetal growth patterns, and positioning to anticipate possible delivery challenges. When signs point to a high-risk birth, proactive planning becomes essential. Once labor begins, the medical team’s ability to recognize risks in real time is critical. A baby in breech position or showing signs of distress may require a rapid shift in strategy. In such moments, seamless communication among obstetricians, nurses, and support staff ensures everyone is aligned and focused on the safest path forward.

Safe Practices During Delivery

Preventing injury during childbirth often comes down to the techniques used in moments of pressure. When a baby’s shoulder becomes lodged, applying controlled, gentle traction rather than forceful pulling can significantly reduce the risk of nerve damage. Medical teams trained in these maneuvers are more likely to achieve a safe outcome, especially in difficult presentations.

Instruments like forceps or vacuum extractors can be lifesaving when used appropriately, but their misuse can lead to facial nerve injuries or trauma to the neck and shoulders. Choosing when to use these tools—and when to consider a cesarean section instead—requires good judgment and a clear understanding of maternal and fetal conditions. In some cases, opting for a surgical delivery can prevent avoidable complications.

Training, Protocols, and Team Readiness

Medical teams best positioned to prevent injuries are those who prepare extensively before emergencies arise. Regular training updates, skills workshops, and simulated delivery scenarios help maintain readiness. These exercises sharpen decision-making and reinforce protocols under pressure, which can be critical during complex births. When everyone knows the steps to take and how to act swiftly, the risk of preventable injury drops significantly.

When a delivery results in a suspected injury, early evaluation by specialists can greatly impact the long-term recovery. Prompt diagnosis allows for quicker access to physical therapy, and in some cases, patients benefit from early surgical consultation if the injury is severe or unresponsive to therapy.